Hutchinson Adam G, Gooden Benjamin, Lyons Matthew C, Roe Justin P, O'Sullivan Michael D, Salmon Lucy J, Martina Kaka, Pinczewski Leo A
School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia.
North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia.
ANZ J Surg. 2018 Oct;88(10):1056-1060. doi: 10.1111/ans.14814. Epub 2018 Sep 2.
The aim of this study was to compare patient-reported outcomes 6 months after hip or knee arthroplasty in subjects who were discharged to home compared to those who attended inpatient rehabilitation.
Seven hundred and forty-eight consecutive total hip or knee replacement patients were identified from a prospective database. Preoperative and 6-month post-operative patient-reported outcome measures were recorded. Forty-four patients discharged directly to home were cohort matched by age, gender, procedure and surgeon to 44 patients from the cohort who received inpatient care. Patient outcomes were compared using SPSS version 24 software.
Both cohorts saw significant improvements from baseline at 6 months. Median length of rehabilitation for the inpatient group was 7 days (4-16 days). There was no significant difference between the groups based on patient-reported outcomes. There was a clinically significant difference (P = 0.047) in the body mass index of the Home Group (mean = 27) to Rehab Group (mean = 29).
Our study has shown that inpatient rehabilitation after hip or knee arthroplasty did not positively affect 6-month patient-reported satisfaction, expectation, pain, quality of life, activities of daily living scores, when compared with subjects who were discharged direct to home. A significant average saving of $5600 per patient with the use of home discharge is a promising avenue for health cost reduction, and health resource distribution.
本研究的目的是比较髋关节或膝关节置换术后6个月回家休养的患者与接受住院康复治疗的患者的患者报告结局。
从一个前瞻性数据库中识别出748例连续的全髋关节或全膝关节置换患者。记录术前和术后6个月患者报告的结局指标。将44例直接回家休养的患者按照年龄、性别、手术方式和外科医生与队列中44例接受住院治疗的患者进行匹配。使用SPSS 24版软件比较患者结局。
两个队列在6个月时均较基线有显著改善。住院组的康复中位时长为7天(4 - 16天)。基于患者报告结局,两组之间无显著差异。回家休养组(平均体重指数 = 27)与康复组(平均体重指数 = 29)的体重指数存在临床显著差异(P = 0.047)。
我们的研究表明,与直接回家休养的患者相比,髋关节或膝关节置换术后的住院康复对6个月时患者报告的满意度、期望、疼痛、生活质量、日常生活活动评分没有积极影响。采用回家休养方式,每位患者平均可显著节省5600美元,这是降低医疗成本和合理分配医疗资源的一个有前景的途径。